title: Validation of the prognostic relevance of plasma C-reactive protein levels in soft-tissue sarcoma patients.
abstract: BACKGROUND
  The concept of the involvement of systemic inflammation in cancer progression and metastases has gained attraction within the past decade. C-reactive protein (CRP), a non-specific blood-based marker of the systemic inflammatory response, has been associated with decreased survival in several cancer types. The aim of the present study was to validate the prognostic value of pre-operative plasma CRP levels on clinical outcome in a large cohort of soft-tissue sarcoma (STS) patients.
  
  
  METHODS
  Three hundred and four STS patients, operated between 1998 and 2010, were retrospectively evaluated. CRP levels and the impact on cancer-specific survival (CSS), disease-free survival (DFS) and overall survival (OS) were assessed using Kaplan-Meier curves and univariate as well as multivariate Cox proportional models. Additionally, we developed a nomogram by supplementing the plasma CRP level to the well-established Kattan nomogram and evaluated the improvement of predictive accuracy of this novel nomogram by applying calibration and Harrell's concordance index (c-index).
  
  
  RESULTS
  An elevated plasma CRP level was significantly associated with established prognostic factors, including age, tumour grade, size and depth (P<0.05). In multivariate analysis, increased CRP levels were significantly associated with a poor outcome for CSS (HR=2.05; 95% CI=1.13-3.74; P=0.019) and DFS (HR=1.88; 95% CI=1.07-3.34; P=0.029). The estimated c-index was 0.74 using the original Kattan nomogram and 0.77 when the plasma CRP level was added.
  
  
  CONCLUSIONS
  An elevated pre-operative CRP level represents an independent prognostic factor that predicts poor prognosis and improves the predictive ability of the Kattan nomogram in STS patients. Our data suggest to further prospectively validate its potential utility for individual risk stratification and clinical management of STS patients.
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Szkandera
authors.forename: A
authors.initials: A
authors.lastname: Gerger
authors.forename: B
authors.initials: B
authors.lastname: Liegl-Atzwanger
authors.forename: G
authors.initials: G
authors.lastname: Absenger
authors.forename: M
authors.initials: M
authors.lastname: Stotz
authors.forename: H
authors.initials: H
authors.lastname: Samonigg
authors.forename: W
authors.initials: W
authors.lastname: Maurer-Ertl
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.forename: F
authors.initials: F
authors.lastname: Ploner
authors.forename: A
authors.initials: A
authors.lastname: Leithner
authors.forename: M
authors.initials: M
authors.lastname: Pichler
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012509:Sarcoma / Q000097:blood* / Q000378:metabolism / Q000473:pathology*; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein